Provider Demographics
NPI:1659493658
Name:PAI, SHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAN
Middle Name:
Last Name:PAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FAIRMOUNT AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3624
Mailing Address - Country:US
Mailing Address - Phone:510-527-8865
Mailing Address - Fax:
Practice Address - Street 1:6431 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3655
Practice Address - Country:US
Practice Address - Phone:510-527-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90513207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology